What are the ESMO guidelines for the treatment of metastatic bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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European Society for Medical Oncology (ESMO) recommendations for treatment of metastatic bladder cancer are as follows [146] :

  • Radical cystectomy with pelvic lymphadenectomy

  • Age is not a limiting factor for surgery (however, 6-month overall survival is lower in octagenarians than in patients younger than age 80)

  • Organ preservation therapy is reasonable for patients seeking an alternative to cystectomy or as a palliative treatment for those who are medically unfit for surgery

  • External beam radiotherapy may be considered as part of a multimodality bladder-preserving approach

  • Cisplatin-based neoadjuvant chemotherapy is appropriate before radical cystectomy or radiotherapy; standard regimens include GC and MVAC

For patients who cannot receive cisplatin-based chemotherapy, palliation with carboplatin-based regimen or single-agent taxane or gemcitabine is an option.

There is insufficient evidence for the routine use of adjuvant chemotherapy; high-risk patients who did not receive neoadjuvant chemotherapy may benefit from adjuvant treatment.

When the patient is unfit for cystectomy, radiotherapy can also be offered for palliation (bleeding, pain)

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